It's the feeling of being worthy of a proper degree of honour, an inalienable right even, to be treated ethically and with respect by others. It is a concept that has fascinating moral, ethical (and political) undertones. After all, it also implies the fundamental status of the person in deserving to be respected.
Dignity is something all care organisations – and especially those working with older and vulnerable people – say they aspire to deliver round the clock, to all those in their care. Yet, despite the reams of words written about dignity by care organisations and the NHS, and even though it is a proscriptive term, in reality, it is not something that can be "done" to people, for it is also subjective. And sadly, the way in which "dignity" is increasingly bandied about, may have had the effect of devaluing it in care.
None of us can dignify an older person if we don't make the effort to get to know them, even a little. Yet so often, "dignity" is referred to as almost a palliative. Those eager to instill a sense of deeper care of others can appear to be more concerned with the way a person is addressed than other, more vital aspects, such as discovering, respecting and valuing who the person is. This is all wrapped up with what their outlook on life is, what their life experiences have been and how these contribute to who they are now.
We can hardly honour and respect a person if we know nothing of them, except on a very superficial level. If there was greater recognition that we are all the sum of our life experiences at whatever age (and that this changes as we age, even in old age); that this alone is an imperative to honour and respect others – we'd be half way there.
Old age is often an attack on person's identity. The last stage of life is often an extremely challenging time for people, being characterised by a spectrum of attendant personal and physical humiliations, include a wide variety of health "invasions" of one sort or another, living with long-term conditions, bereavement and a wide range of other (sometimes no less painful) losses.
So what is dignity? It is about self-respect and respect for others. It reflects on the care-giver as well as care-receiver. But this is challenged by illness, loss of capacity for self-care.
Older people's health problems pose challenges to their sense of independence, their dignity and their identity – their self-respect. Sometimes the health care they're given makes things worse.
A recent study, 'Maintaining dignity in later life: a longitudinal qualitative study of older people's experiences of support and care' funded by UK Research Council's New Dynamics of Ageing programme (NDA), and led by Dr Lloyd of the University of Bristol and colleagues from the Universities of Kent, Bristol and Nottingham, discourages healthcare providers from taking a 'blanket view' of how to help older people cope with the ageing process.
As the report says, "people are often surprised by the impact that illness and growing old has on their lives and that their sense of 'self' is affected by the limitations imposed by their age and illnesses."
"Older people work hard at maintaining their health and independence, while coming to terms with becoming dependent on others. With the struggle to maintain day-to-day activities, their dignity can quickly and easily be lost."
Researchers identified the factors that impact on people's lives.
Participants were interviewed in depth about the changes to their lives, their experiences of care and support and how it affected their dignity. The study followed 34 people between 70 and 90 who lived at home and had a range of health problems that required support and care.
As Dr Lloyd comments, "Growing old and coming to terms with illnesses is complex and demanding at times - physically, mentally and emotionally. When health goes, it can come as quite a shock."
One person in the study observed, "inside, I feel as though I ought to be able to do things. But I'm not and it's hard to accept."
Dr Lloyd believes the research shows there are significant differences in the way that people define dignity and independence, and that these are influenced by their relationships, abilities and life experiences. She says, "You can't impose a blanket view of what dignified care is. Of course, there are certain standards that should apply in all circumstances but enhancing dignity needs a lot more than guaranteeing minimum standards."
"In old age when your health fails, it affects your sense of self. Understanding that from an older person's perspective is crucially important. Care and support can enhance dignity or it can worsen the loss of it if not given in the right way. Good support is essential in terms of how people make the adjustments they need to make."
The relationship between dignity, identity and independence is complex. As Dr Lloyd says, "loss of independence involves a change in your identity and is a challenge to your dignity. It is through the support of others that individuals are able to rebuild their sense of identity in their changed circumstances."
Support and care need to be responsive to what people are going through and to see things from the perspective of the person on the receiving end of care. We have to try to "step into the shoes of others". Older people are going through enormous changes and the people who are helping them need to be aware of these.
Images: Thanks to Fish&
